Clinical Operations Assistant Manager ( USRN UM CMS CM

Recrutly; Quezon City; On-site; PHP 1,200,000 - 2,000,000; Full time

Job summary

Recrutly is seeking a Clinical Operations Assistant Manager to lead a high-performing team for a major US managed care program. The role focuses on service excellence, clinical quality, and staff development in a fast-paced, metrics-driven environment.

The ideal candidate holds a BSN with active PH RN license and an active US RN license (NCLEX). You will manage SLAs/KPIs, drive trainings, and ensure HIPAA compliance while working onsite in Quezon City during US daytime hours.

Qualifications

• BSN with active Philippine RN license (PHRN).
• Active USRN license (NCLEX passed).
• At least 5 years of clinical and healthcare operations experience.
• At least 3 years of team leadership experience in healthcare BPO or shared services.
• Strong knowledge of US managed care, UM/CM, CMS, and HIPAA.
• Proven experience managing SLAs, KPIs, and clinical operational performance.
• UR/UM background with current UR management experience is preferred.
• URAC/NCQA standards familiarity is an advantage.
• Willing to work onsite on a US day shift.

Responsibilities

• Own daily SLA/KPI performance metrics (turnaround time, quality, productivity, documentation).
• Conduct team huddles, interval monitoring, RCA, and performance recovery planning.
• Ensure strict HIPAA and PHI compliance.
• Lead clinical quality assurance through audits, calibrations, coaching, and reviews.
• Develop and mentor RNs, clinical associates, and team leaders.
• Manage competency programs, preceptorship, CE tracking, and license validity.
• Collaborate with WFM, TA, QA, and client stakeholders.
• Translate clinical protocol updates into practical workflows and training materials.

Skills

Team leadership

SLA/KPI management

Clinical operations

HIPAA compliance

US healthcare knowledge

Education

BSN

Job description

Job Title: Clinical Operations Asst. Manager (Manager)

Program: Healthcare – Hybrid Voice and Back-Office Operations

Work Location: Vertis North, Quezon City

Work Setup: Onsite

Shift Schedule: US Day Shift

***Salary: Open, depending on the candidate’s current or previous salary, experience, and qualifications. Salary expectations should remain reasonable and aligned with the client’s budget.***

Target Start Date: On or before December 15

Headcount: 1

Job Overview

Lead a high-performing clinical operations team supporting a major US managed care program. Drive service excellence, clinical quality, and team development in a fast-paced, metrics-driven environment.

Key Responsibilities

• Own daily SLA/KPI performance, including turnaround time, quality, productivity, and documentation.
• Conduct team huddles, interval monitoring, root cause analysis (RCA), and performance recovery planning.
• Ensure strict compliance with HIPAA and PHI requirements.
• Lead clinical quality assurance through audits, calibrations, coaching, and documentation reviews.
• Develop and mentor registered nurses (RNs), clinical associates, and team leaders.
• Manage competency programs, preceptorship, continuing education (CE) tracking, and license validity.
• Collaborate with Workforce Management (WFM), Talent Acquisition (TA), Quality Assurance (QA), and client stakeholders.
• Translate clinical protocol updates into practical workflows and training materials.

Qualifications

• Bachelor of Science in Nursing (BSN) graduate with an active Philippine RN license.
• Active, unrestricted USRN license (NCLEX passed).
• At least 5 years of clinical and healthcare operations experience.
• At least 3 years of team leadership experience in healthcare BPO or shared services.
• Strong knowledge of US managed care, Utilization Management (UM), Case Management (CM), CMS, and HIPAA.
• Proven experience managing SLAs, KPIs, and clinical operational performance.
• Background in Utilization Review (UR)/Utilization Management (UM), with current experience managing UR operations.
• Experience in UM, CM, Health Risk Assessment (HRA), triage, or payer operations is preferred.
• Familiarity with URAC/NCQA standards is an advantage.
• Training experience is preferred.
• Willing to work onsite on a US day shift.

USRN License Validity

***USRN License Validity: The license must be active. Candidates whose licenses are nearing expiration must be willing to renew it.***

Required Assessment

Candidates must complete an on-the-spot clinical review writing assessment during the interview.

Please advise candidates in advance that a laptop or desktop computer is required to complete the assessment.

Recruitment Process

• Profile Validation
• Profile Review
• Talent Acquisition (TA) Interview
• Hiring Manager (HM) Interview
• Client Interview

Pre-Screening Notes

1. Educational Attainment:
2. Years of Clinical and Healthcare Operations Experience:
3. Years of Leadership Experience in Healthcare BPO/Shared Services:
4. UR/UM Background: Do you have experience in Utilization Review (UR) and Utilization Management (UM)? Please provide details.
5. Licenses: Do you have an active Philippine RN (PHRN) license and an active, unrestricted USRN license? When do your licenses expire?
6. Training Experience: How many years of experience do you have in clinical training or education?
7. Last Drawn Salary:
8. Expected Salary: